Archive forJuly, 2013

Rhonda Robinson Beale, M.D. is the Chief Medical Officer of External Affairs for Optum, a leading service organization of mental health and substance use solutions. As the Chief Medical Officer, Dr. Robinson Beale focuses on the organization relationship with external organizations, legislation and public policy.

Dr. Robinson Beale has more than 20 years of behavioral health and quality management experience and is an active member of the behavioral health community. She is on the National Institute of Mental Health Advisory Council and sits on NQF MAP committee for dual eligibles. She has been involved with the National Committee for Quality Assurance (NCQA) as a surveyor; a member of the Review Oversite Committee (ROC), which makes accreditation decisions; and a member of advisory panels that constructed the initial MBHO and disease management standards. She has also been a member of the board of directors for the Institute of Medicine’s (IOM) Neuroscience and Behavioral Health and Health Care Services Boards. Dr. Robinson Beale was a member of the committee that produced the groundbreaking reports: “To Err is Human,” and “Crossing the Quality Chasm,” She has been involved in other IOM reports such as “Cancer Care for the Whole Patient” and “Provisions of Mental Health Counseling Services Under TRICARE”.

Dr. Robinson Beale has served on the National Quality Forum Board of Directors as the co-chair for the ‘Evidence-Based Practices to Treat Substance Use Disorders’ Steering Committee. Additionally, Dr. Robinson Beale serves on the Board of Directors for American Managed Behavioral Healthcare Association (AMBHA) as well as the Washington Circle Policy where she serves on the policy committee responsible for creating Alcohol and Other Drugs (AOD) measures for HEDIS.

Before joining Optum, Dr. Robinson Beale was Chief Medical Officer for PacifiCare Behavioral Health. She also served as senior vice president and chief medical officer for CIGNA Behavioral Health, national medical director for Blue Cross Blue Shield, executive medical director of medical and care management clinical programs for Blue Cross Blue Shield of Michigan, and senior medical director for behavioral medicine for Health Alliance Plan. She was also a provider in the Detroit community owning and operating a capitated behavioral health practice for over 20 years that serviced over 40k commercial and Medicaid members.

Dr. Robinson Beale received her medical degree from Wayne State University and her psychiatric training at Detroit Psychiatric Institute. She is certified in psychiatry by the American Board of Psychiatry and Neurology.

Craig Escudé, MD is a board-certified family physician and serves as medical director of Hudspeth Regional Center, a state residential program for those with severe and profound intellectual and developmental disabilities in Mississippi. He has over 16 years of experience in caring for those with mental and developmental issues in central Mississippi. Over the past two years, his involvement with transitioning individuals from congregate to community settings has taken him from an inquisitive skeptic to a realistic, rational supporter of this endeavor. He has traveled to and communicated with other states to learn both the positive aspects as well as the challenges associated with this transition and has presented to numerous groups on the subject. He is currently actively participating in the design of the transition process in Mississippi, especially in areas relating to medical care for individuals with intellectual and developmental disabilities.

A major feature of the Affordable Care Act is the creation of health homes that span behavioral health and primary care. Hence, a major agenda going forward is the creation of integrated care systems that span these services. Although referral and collaboration models are available, full integration at the same site is the preferred model. This session will discuss the integration of behavioral health into primary care and the integration of primary care into behavioral health. The former approach will reach a large number of persons with behavioral health conditions, because more than 60 percent of behavioral healthcare now occurs in primary care settings. The latter approach typically will reach persons who have more severe behavioral health conditions, and who require more intensive care. Both models are likely to emerge in the ACA era.

The implementation of the Affordable Care Act and Medicaid Reform that is being enacted in many states has led to a focus on the development of models for integrated care, coordinated care models and the development of health homes as a way to manage service delivery and the purchase of care. State Medicaid agencies are increasingly contracting with managed care and behavioral health managed care companies as a mechanism for implementing these models. The network of service providers under these models are typically comprised of a wide range of private providers as well as specialty mental health providers such as community and county mental health and/or substance abuse agencies. Although managed care companies contract directly with the State Medicaid agency, state agencies with responsibility for mental health and substance abuse services are often involved in planning and discussions with regard to the purchase of services that have previously or are currently under their purview. This session will focus on the implementation/expansion of the role of managed health and behavioral health care companies in the delivery of behavioral health care services in the era of Medicaid Reform. How will managed care address the integration of primary health and primary health, quality of care issues, provider network issues and service delivery? How will the services provided by managed care companies interface with state mental health and substance abuse authorities, county authorities and with specialty mental health and substance abuse providers who may find themselves contracting with state funders in addition to managed care entities?